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Pseudoephedrine For Infants: The BEST (unless you are an idiot)

[edit-explanation:] the dosing schedule / dosage by weight information you want is at the bottom of the page. There is a little math involved. The top of this page is all ranting; feel free to scroll down.[/edit-explanation]

In 2005-2006, the world for Central Texans (highest allergy prescription rate in the country last I heard) and all those who ever suffered from a stuffy or runny nose, or sinus headache, changed forever. 3 children died. And somebody figured out that you can make illegal substances out of legal ones.

Congress decided to Do Something(!)

What they did would not have prevented those childrens’ deaths, and it has probably never caused one gram fewer of methamphetamine to be manufactured in a speed-freak’s basement. As with almost everything Congress can do, it only made life harder for the already-law-abiding, and the criminals and the criminally stupid will go on as if nothing much has happened.

Now, instead of going to the appropriate aisle in any store that sells medicine and buying it like any other helpful thing, you have to go to the pharmacy counter at a major retailer (if the pharmacy is open, if not tough cookies) and swipe somebody’s driver’s license in a scanner. No comment on the security of the system, which is somewhat like a colander for keeping water secure, but I digress.

To review: if you have sinus pressure, a sinus headache, a runny or stuffy nose, or itchy, watery eyes, you want an appropriate dose of pseudoephedrine, PERIOD.

If you take too much of any drug, you will get hurt. This is no exception. If you can’t figure out how much of a drug you should give yourself you either a) went to government school, or b) are somewhere between a moron and and an idiot (literally). If you know how much to give yourself, but can’t figure out how much to give to a child, you need to either a) consult a pediatrician or b) sit down with a pencil and figure it out, which should be free and cost about 3 minutes of your time.

For me, giving a small child a dose of medicine based on their weight is simple. For almost everyone, at least using the dose-by-age chart right on the bottle of medicine is simple. But at least 3 parents were thick enough to overdose their children on pseudoephedrine and kill them, in 2005. That’s 3, out of probably a hundred million or more successful reliefs of miserable children by proper dosage of pseudoephedrine, including what I gave my own children. Thanks, and good job spoiling it for the rest of us. But this was just one shoe.

The other shoe dropped when the feds made it a slight hassle to acquire this, the most useful of all OTC cold remedies. Of course, introducing a minor obstacle for consumers eventually led to substitution with a medicine that basically doesn’t work, and sales of the good stuff fell off a cliff, and the infants’ and toddlers’ packaged pseudoephedrine was pulled by the manufacturers, due to lack of profits for the safety of the children.

So now, instead of messing up the dose for an infant (do they get 1/2 or 12 droppers full?) we will have mouth-breathing parents out there (this is literal, not a pejorative, consider the topic of this essay) trying to figure out dosage for a 20lbs. person based on the dosage chart for a 100lbs person, with a wholly inadequate measurement system (how many times can you logically divide a tablespoon? milliliters, anyone?)

So, here’s what you find when you google “pseudoephedrine for infants”, basically verbatim, everywhere on the Internet:

You paid for all this, remember. Everything in brackets and all emphases are mine.

“The U.S. Centers for Disease Control and Prevention recommends that parents not administer over-the-counter cough remedies to children under the age of 2 without first consulting a doctor.

“This recommendation was based on a 2005 investigation of the deaths of 3 infants who were 6 months old and younger, who died of a fever after consuming cough syrup containing pseudoephedrine. The investigation found that the infants had levels of the decongestant that was up to 14 times the recommended pseudoephedrine dosage for children between 2 and 12 years of age. “

“In January 2006, NAME, in collaboration with CDC, initiated an e-mail inquiry, requesting reports of deaths in infants aged other than those from media [read: the ones you saw on the news were the only ones] and published reports were identified. From these reports, CDC identified [only!] three cases of infant deaths in two states during 2005 that were determined by a medical examiner or coroner to have been caused by cough and cold medications

“The three infants ranged in age from 1 to 6 months; two were male. All three infants had what appeared to be high levels of pseudoephedrine (a nasal decongestant) in postmortem blood samples. The blood levels of pseudoephedrine ranged from 4,743 ng/mL to 7,100 ng/mL.† One infant (patient 2) had received both a prescription and an over-the-counter cough and cold combination medication at the same time; both medications contained pseudoephedrine“[!]

“In another action, the availability of pseudoephedrine-containing medications has been affected by the federal Combat Methamphetamine Epidemic Act, which was signed into law March 9, 2006 [thanks President Bush!]. This act bans over-the-counter sales (but permits behind-the-counter sales in limited amounts) of cold medications that contain pseudoephedrine, which can be used to make methamphetamine. Because of this act, pseudoephedrine has been removed as an ingredient in many cough and cold medications and replaced with other nasal decongestants. . . .As an alternative to pseudoephedrine and other nasal decongestants, caregivers might consider clearing nasal congestion in infants with a rubber suction bulb; secretions can be softened with saline nose drops or a cool-mist humidifier.” [note: this (deleted) does NOT work for more than a few minutes, unless your goal is to have a screaming baby. Oh, and you can give them a bloody nose with the suction bulb]

“The dosages at which cough and cold preparations can cause illness or death in pediatric patients younger than 2 years of age are not known, and there are no specific dosage recommendations (i.e., approved by the US Food and Drug Administration [FDA]) for the symptomatic treatment of cold and cough for patients in this age group. (See Dosage and Administration: Dosage.) Because of the absence of dosage recommendations, limited published evidence of effectiveness, and risks for toxicity (including fatal overdosage), CDC and FDA state that parents and other caregivers should not administer cough and cold preparations to pediatric patients younger than 2 years of age without first consulting a clinician and should follow the clinician’s instructions precisely.”*

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And finally, the money shot:(I was actually looking for these data when I started out on the ‘web tonight)INFANTS’ TYLENOL COLD PLUS COUGH (=the best medicine, EVAR, for minor nasal problems in infants)Ingredients:per 1.6ml (two dropperfuls)

It is safe to use in children six months and older for upper respiratory illness (such as colds and sinus infections). If your child has a lower respiratory tract illness (like pneumonia, bronchiolitis or asthma) you should ask your physician before using cold or cough remedies.

Okay, so let’s say I have a 6 month-old infant with sinus drainage and a boogery nose. He weighs 20lbs. I go to the chart and find I should give him . . . carry the 2 . . . 1.2ml per dose, about every 6 hours.

Now thanks to your Elected Heroes in Congress, I have to do some advanced calculus and geometry to get the proper dose for my baby.

I have before me in my baby-smelling fingers a bottle of Non-Drowsy children’s [sic] Sudafed Nasal Decongestant, 4fl. oz (118ml). I turn it over and let’s see… children 2 to 6 years of age, 1 teaspoonful. here it is Drug Facts: Active ingredient in each 5 mL (1 teaspoonful) [there’s a graduated beaker for dosing and it’s marked in both so everybody is happy and warm and fuzzy when drugging up Jr.] sorry, where was I?

Okay, where have I seen that number before? oh, wait, that’s exactly the same dose as the wonderful-but-discontinued Infants Tylenol Cold Plus Cough, in 1.6ml (two droppersful)!

But I wanted 1.2ml of that stuff… so let me get the calculator out again…5ml Sudafed = 1.6ml Tylenol (if that’s all you can read out of this whole essay, please, go ask your doctor)1.2/1.6=0.75. I want 0.75x the two droppersful dose. That’s5 * 0.75 = 3.75. 3.75ml of the Sudafed juice is the same as 1.5 droppers of the Tylenol juice.

Great, now I get to make my baby swallow almost 4ml of medicine instead of less than 1.5ml. Thanks, Congress!

7 thoughts on “Pseudoephedrine For Infants: The BEST (unless you are an idiot)”

I cannot believe that in two and a half years no one has commented on this. But a few months ago the Dr Sears site still had dosing info for all the cough medicines for all ages, and now they've pulled it. It's KILLING me! I am also irritated beyond belief that three stupid parents have for some reason caused congress to think that the rest of the US population is stupid also. If I don't get some sleep I may end up being… Anyway thanks for posting the dosing amounts.

"Safe Cures for Kids’ Common Colds", an article from Boston University's "BU Today" provides a nice counterpoint to your article. In particular, one point missing from your article is that the efficacy of pseudoephedrine on children is unknown.

glenviewjeff, you are a counterpoint to people who can pass a reading comprehension test with flying colors. Good job finding an article on the same topic as mine, written after mine, with LESS information than I gave you. Bravo.The efficacy of pseudoephedrine on children is known with 100% certainty. The stuff works like [deleted] MAGIC. How do we know? Because ALL OF MY FOUR CHILDREN have less sinus pressure, headache, runny nose, itchy eyes, etc. after taking only a dose of pseudoephedrine calculated on body weight, as I explain how to do above. NOTHING else is as effective for relieving cold or seasonal allergy symptoms in children from 6 months to 2 years, to 20 years. You want to read something that will really flip your wig? When we can't get liquid kid's sudafed, we grind up adult doses in a mortar & pestle, and divide THAT for the babies. You know what? They somehow live through it.Overdose and kill them, heed the nanny state warnings and let them suffer, or spend a minute thinking and give them relief? Hmm, let's see here . . .

YES!!!! I totally agree!!! I stumbled across this today when trying to find out if there were any backdoor methods to acquiring infant formulations of cold meds, from other countries etc. Your points are my points exactly–right down to the fact that it is a major pain in my A$$ that I now have to fight with my infant to get down 3 or 4X as much liquid to relieve her suffering thanks to a combination of brainless moronic parents, brainless moronic bureaucrats, and spineless paper pushers who don't care about anything but CYA. And I will tear anyone a new one who even tries to start spewing the "ineffectiveness" BS about pseudoephedrine. It works for me, it has worked 100% of the time it was used for my six year old son. Drowning on his own snot and rattling chest to sleeping and breathing silently in 20-30 mins is pretty indisputable proof. If it wasn't the pseudoephedrine, then what the hell was it? Cosmic star alignment??

I knew I couldn't be the only parent out there frustrated with the inability to give my 6 month old any relief from his cold symptoms (going on two months now!). My pediatrician looked at me like I was crazy today when I said I remembered using OTC meds on my older kids (born in 2000 and 2002). Thanks for helping me prove to myself I wasn't the moron in the exam room today. Best. Blog post. Ever.